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Archive Staff & Patient Safety 2018

5 Steps to Smoke-Free Surgery

Your staff will breathe a collective sigh of relief when you clear the OR air of harmful contaminants.

Joann Ruff

Joann Ruff, BSN, CNOR


Pamela Bevelhymer, RN, BSN, CNOR
BUDGETARY HURDLE If disposable electrocautery pens are included in your surgical packs, it could be difficult to justify adding smoke evacuators.

Last June, Rhode Island became the first state in the nation to mandate the evacuation of surgical smoke during plume-producing procedures performed in hospitals and surgical centers. Perioperative nurses around the country celebrated the news and hoped their state would be next to protect them from dangerous pollutants that waft through the OR air. Why wait for state legislators to force your hand when you already have the authority to transform your ORs from smoky dens to smoke-free work spaces?

1. Know the risks

The long-term effects of exposure to surgical smoke may not be fully understood yet, but the list of potential hazards contained in plume reads like a sign at a toxic waste site. There's benzene, for example, which can cause anemia by suppressing the production of red blood cells, and which can also damage the immune system by altering blood levels of antibodies. There's hydrogen cyanide, which is potentially deadly, because it prevents cells from properly absorbing oxygen. There's also formaldehyde, which can cause a whole host of problems, including nasal and eye irritation, sore throats, nosebleeds, neurological effects and an increased risk of asthma.

Those are just a few of the concerns. Smoke particles travel fast — up to 40 mph. When electrosurgical units are activated, the concentration of particles can quickly increase from 60,000 particles per cubic foot to more than 1 million particles per cubic foot. It takes another 20 minutes for levels to return to normal.

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